Provider Demographics
NPI:1790735991
Name:XENOPHONTOS, XENOPHON PARASEKA (MD)
Entity Type:Individual
Prefix:
First Name:XENOPHON
Middle Name:PARASEKA
Last Name:XENOPHONTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1882
Mailing Address - Country:US
Mailing Address - Phone:516-227-2721
Mailing Address - Fax:516-227-0564
Practice Address - Street 1:231 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1882
Practice Address - Country:US
Practice Address - Phone:516-227-2721
Practice Address - Fax:516-227-0564
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1924152086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01609838Medicaid
020031357OtherRR MEDICARE PIN
G07046Medicare UPIN
NY236951Medicare PIN